Petition For Benefits
If an insurance company refuses to pay the injured employee benefits by denying a claim, he or she may file a petition for benefits with the Florida Division of Administrative Hearings. The petition is then sent to a local Office of the Judges of Compensation for processing.
Once an insurance company receives a notice of a petition for benefits, they have 14 days to either pay the claim or respond to the petition with the Office of Judges of Compensation. The insurance carrier must explain to the judge all of the benefits requested and reasons for denying their dispersal.
After receiving the insurance company’s response, the judge’s office schedules a legally mandated mediation conference to try and resolve the claim out of court. Mediation must take place within 130 days of the filing for petition of benefits.
The mediator is an independent party utilized to facilitate a settlement. At mediation, there is no evidence or testimony taken and the information discussed cannot be used in appeals hearings. Furthermore, the mediator’s recommendations, if any, are not binding and are merely suggestions on how to best bring the matter to a close.
Should attempts at mediating the claim be unsuccessful, the judge overseeing the case will schedule a pretrial conference to lay the groundwork for the upcoming hearing. The purpose of a workers’ compensation pretrial hearing is to:
A final hearing will take place no more than 210 days after the petition for benefits is filed. The final hearing is essentially a trial in front of a judge to try and settle a claim once and for all. During the final hearing, each side’s attorney will call and cross examine witnesses, scrutinize evidence and expert reports, and advocate vigorously for their client’s legal interests.
Shortly after the conclusion of the final hearing, the judge will issue his or her final decision on the matter. Appeals to the final ruling may be filed and if accepted will be heard by a three-judge panel of the Florida First District Court of Appeal. Appellate judges usually only overturn the lower judge’s ruling if the judge failed to properly apply the law or if the ruling does not support the facts of the case.